An Analysis of 30-Day Readmissions of Surgically Managed Hiatal Hernia in the United States, 2010 to 2018

Background: Longitudinal national data on 30-day readmissions after hiatal hernia (HH) repair has not yet been fully explored. Methods: Data was obtained from the National Readmissions Database (NRD) for patients undergoing HH repair between 2010 and 2018. Univariable and multivariable logistic regression analyses reported with odds ratio (OR) and 95% confidence intervals (CI) were performed to identify factors associated with 30-day readmission. Interventions and procedures performed during readmission were extracted using International Classification of Disease (ICD)-9 and ICD-10 codes. Results: A total of 113 928 patients met inclusion criteria. Of these patients, 7492 (6.58%) were readmitted within 30 days of their initial hiatal hernia repair. Factors associated with readmission included age, diagnosis of frailty, non-elective admission for the index procedure and open approach. The median total cost of the readmission event was $29 845. On multivariable logistic regression, factors associated with 30-day readmission included frailty (OR = 1.17, P = .04), index admission status (non-elective, OR = 1.18, P < .001), Medicare (OR = 1.27, P < .001) or Medicaid insurance (OR = 1.36, P < .001), repair approach (open, OR = 1.14, P < .001), and initial length of stay (OR = 1.03, P < .001). On readmission, patients underwent a range of procedures, but only a small proportion required hiatal hernia re-repair. Conclusion: There are notable demographic differences between the non-readmitted and readmitted cohorts, as well as specific risk factors associated with readmission within 30 days of hiatal hernia repair. Further research is necessary determine population-specific methods to prevent readmission in the highest risk cohort.